Electronic Submission For Dental Predeterminations May Increase Efficiency, Patient Satisfaction

Many dentists and dental office staff have realized the benefits of electronic claim submission; however, very few dental professionals have taken advantage of electronic predeterminations. These electronic transactions may increase office efficiency, while offering the convenience of determining benefit information while the patient is still in the office.


"Paper submissions typically take 10 to 14 business days to process. By using a real-time claim transaction processing system, dental offices can receive immediate benefit predeterminations," said Theresa Jansen, manager of Dental Electronic Services for United Concordia. "And, the process is nearly identical to an electronic reimbursement submission. The only differences are selecting the appropriate indicator in your software/desk top product for a pre-treatment estimate and omitting the dates of service."


To further assist in streamlining the electronic predetermination process, many insurers accept electronic attachments and offer x-ray exemption programs for offices with appropriate utilization history.


"United Concordia, like many other insurers, is committed to providing efficient services to dental offices. We believe electronic predeterminations can help reduce both cost and paperwork, while enhancing patients' experiences," said Jansen.


Electronic predeterminations should, in most instances, be used to estimate the extent of coverage for a proposed course of treatment. Most insurers suggest predeterminations for the following non-emergency types of treatments, including onlays, single crowns, prosthetics, periodontics and orthodontics.


"It is important to remember that a predetermination is only an estimation of a patient's benefits. A predetermination does not guarantee payment of benefits and should only be used as a tool for the patient and his/her dentist to plan a course of treatment," said Jansen.


For more information on Electronic Submission for Predeterminations, dentists and dental office staff should contact their clearinghouse/vendor or the appropriate insurance carrier.


About United Concordia Dental


United Concordia Companies, Inc., headquartered in Harrisburg, Pa., is one of the nation's largest dental insurers, with more than 7.7 million members worldwide. In 2007, United Concordia processed more than 13 million claims and attained revenues of 1.3 billion. For more information about United Concordia products, visit our Web site at unitedconcordia.


United Concordia Companies, Inc.

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